Surgical treatment results in patients detected to have single station N2 in lung cancer resection

Abstract

Objectives: This study aims to investigate why “incidental N2” patients were not detected preoperatively and which “incidental N2” patients had superior survival.

Patients and methods: The study included 32 patients (26 males, 6 females; mean age 63.5 years; range, 30 to 77 years) detected to have single station mediastinal “incidental N2” lymph node metastasis out of 597 patients operated due to primary lung cancer in the Thoracic Surgery Department of Medical Faculty of Istanbul University between January 2001 and November 2008. Patients were separated into three groups with regard to metastatic lymph node stations: Group 1: patients detected to have metastasis in aorticopulmonary (numbers 5 and 6) lymph nodes (n=5, 15.6%), group 2: patients detected to have metastasis in inferior mediastinal (numbers 7, 8 and 9) lymph nodes (n=18, 56.2%), group 3: patients detected to have metastasis in superior mediastinal (numbers 2 and 4) lymph nodes (n=9, 28.2%).

Results: Factors effective on survival and disease-free survival durations were separately analyzed for all patients and groups. In all patients, two- and five-year general survival rates were mean 50.0% and 29.0%, respectively. Five-year general survival rate and disease-free survival rate for groups 1, 2, and 3 were 40.0%-40.0%, 33.3%-44.4%, and 22.2%-28.6%, respectively. A positive and statistically significant relationship was detected between the number of resected lymph nodes and the number of metastatic lymph nodes.

Conclusion: Incidental N2 rate was 5.3% in our study. Thus, actual pathological staging could be performed by correct mediastinal dissection methods. Consequently, with the correct staging in terms of N status of patient, suitable adjuvant oncologic treatment was provided to patient in order to increase the survival duration. For this reason, we emphasize the importance of correct intraoperative mediastinal staging.